Sleep Dentistry

Obstructive Sleep Apnea and Sleep Dentistry

There is probably, in my opinion, no other condition that impacts general health as much as sleep apnea does. Imagine that during your sleep someone chokes you for a whole minute, and repeats this every 5 minutes throughout the whole night. Worst of all, you are not aware of this happening.

In our office we take sleep apnea very seriously, mainly because it seems to be an underlying factor for many conditions. Furthermore, I have noticed that most of my patients who have had braces as teenagers after having had four sound teeth extracted for the purpose of “creating space,” invariably suffer from a multitude of deleterious effects, such as excessive tooth wear, orthodontic relapse, stunted jaw growth, jaw-joint dysfunction, a mid-face deficiency, flat face with lack of proper lip support, insufficient jaw sizes to accommodate proper tongue position, snoring, and sometimes sleep apnea. Many times sleep apnea is an accompanying condition in these patients, due to the fact that the smaller jaws will just not accommodate the tongue, which tends to fall back and obstruct the airway during sleep. As dentists we have to be able to identify the incidence of this serious disorder, and offer treatment after obtaining a diagnosis by a physician.

ADULT SLEEP APNEA FACTS:

  • Obstructive Sleep Apnea, or OSA for short, afflicts 20 million Americans. 9% of men and 4% of women have OSA.
  • Statistically, most heart attacks happen in the early morning hours. Many of these can be blamed on O.S.A.
  • The Anales Medicina de Interna reported in 1999 that patients with untreated sleep apnea have a 37% chance of dying within 8 years.
  • Nasal breathing and an ample oxygen supply encourages nasal and sinus epithelium to produce Nitric Oxide, a tissue mediator which prevents the blood from clotting, protects arteries and dilates blood vessels.

 

CHILDHOOD SLEEP APNEA FACTS:

  • Most growth hormone is produced during the first few hours of sleep.
  • 90% of growth and tissue repair happens during NREM stage 4 sleep.
  • According to the American Academy of Pediatrics, all children should be screened for sleep apnea and treated immediately.
  • Chronic tonsil and adenoid enlargement is the most common cause of childhood sleep apnea
  • Since enlarged tonsils and adenoids are a major cause of sleep apnea and mouth breathing in children, consequentially smaller jaws and dental crowding are also common findings.
  • A survey in the journal Pediatrics from 2001 determined that children who snored during early childhood tended to show poor performance in middle school.

HIGH RISK FACTORS FOR O.S.A.

  • Being overweight
  • Snoring (not all snorers are sleep apneics)
  • Small or underdeveloped jaws
  • Lower jaw too far back in relation to the upper jaw.
  • Narrow upper airway diameter
  • Increasing age
  • Alcohol/tobacco/sedative use

SIGNS OF O.S.A.

  • Snoring, intermittent, with occasional gasping for air
  • Excessive daytime sleepiness
  • Non-refreshing sleep
  • Fatigue and irritability
  • Morning headaches
  • Gastro-esophageal reflux

CONSEQUENCES OF O.S.A. – sleep apnea is considered an independent risk factor for the following conditions

  • Poor memory
  • Increased auto and work-related accidents
  • Poor performance
  • Depression
  • Decreased quality of life
  • Heart problems, increased chances for developing high blood pressure, arrhythmias or stroke
  • Increased risk for adult type II diabetes

Diagnosis of OSA

Because OSA is a life-threatening medical condition, a multidisciplinary approach is necessary to address it. A physician should be involved in diagnosing the presence and degree of sleep apnea. A physician should also conduct an examination to determine if other correlated health conditions exist, such as hypertension, cardiovascular disease, diabetes and chronic fatigue.

Watch-PAT100

We are proud to carry this FDA approved, compact and ambulatory system of sleep monitoring.

In the comfort of your own home, it is a welcome alternative to a stressful and expensive hospital-based sleep study. Based on the results of this study, an on-line pulmonologist’s diagnosis is obtained which allows us to implement treatment much sooner.

Treatment of OSA

For mild to moderate cases of OSA, a dentist may fabricate an oral appliance to allow the airways to remain open for sufficient air to flow into the lungs during sleep. This treatment is far more tolerable than the conventional CPAP machine, which many patients of OSA find very cumbersome to use. (A CPAP is still a requirement for severe sleep apnea cases). In our office, we conduct a thorough evaluation of the multiple contributing factors and signs of sleep apnea, including daytime sleepiness and nighttime sleep evaluation scores. Homeopathic and naturopathic treatment many times provides additional support in improving sleep quality or addressing the hormonal, biochemical and physiological ravages of this condition.

Sleep hygiene

Among other things, the following habits should be implemented to improve sleep quality.

  1. Do not eat dinner within 3 hours preceding bedtime.
  2. Follow a regular sleep routine by not staying up late and not oversleeping.
  3. Cut back on alcohol, soda and caffeine.
  4. Take an herbal supplement or a hot herbal relaxing tea half an hour before bedtime.
  5. Take a warm bath before bedtime.
  6. Do not eat snacks, watch TV or read in bed.
  7. Follow a light and individualized exercise routine, preferably in the morning, and one hour before dinner.
  8. Do not engage in activities that are stressful or mentally challenging before bedtime.
  9. Shut off all lights.

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